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Minerva Chirurgica 2005 April;60(2):83-90

language: Italian

Parathyroidectomy: bilateral exploration of the neck vs minimally invasive radioguided treatment

Sozio A., Schietroma M., Franchi L., Mazzotta C., Cappelli S., Amicucci G.


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Aim. In the therapy of primary hyperparathyroidism, the first surgical intervention, if efficacious, can remarkably reduce the incidence of persistences and relapses which are approximately about 5%. At present, the surgical approach of choice should involve the bilateral exploration of the neck.
Methods. In the light of the high sensibility (91%) and specificity (98.8%) in the localization of parathyroid adenomas obtained by the parathyroid 99mTc-MIBI scintigraphy, we submitted, perspectively and at random, between January 2001 and July 2004, 69 patients with primary hyperparathyroidism, to a conventional surgical treatment (bilateral exploration of the neck: 35 patients) or minimally-invasive approach (minimally invasive radioguided parathyroidectomy: 34 patients). This method consists of the injection of 50 mCi of 99mTc Sestamibi 2 h before the operation and the execution of parathyroid scintigraphy. When the adenoma is evident, we perform an incision of about 4 cm in the neck, 2 cm over the jugulum and the surgical dissection is guided by a probe showing the emission of gamma rays.
Results. The parameters considered in order to compare the 2 groups, i.e. operating time, hospital stay and time of recovery were reduced in a significant way in the group submitted to the minimally invasive radioguided parathyroidectomy (MIRP). There were no complications in the 2 groups. In the follow-up we did not observe cases of persistence or relapses.
Conclusion. Therefore, we can confirm that the minimally invasive radioguided parathyroidectomy is a safe and efficacious method as well as the bilateral exploration of the neck. Moreover, cost reduction may convince many surgeons to consider MIRP the «gold standard» in the management of primary hyperparathyroidism.

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